Healthcare Provider Details

I. General information

NPI: 1639459241
Provider Name (Legal Business Name): MAUREEN O BRAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

IV. Provider business mailing address

610 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

V. Phone/Fax

Practice location:
  • Phone: 678-552-2013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number120108
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH026789
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: